U.S. President Joe Biden receives his coronavirus disease (COVID-19) booster vaccination at the White House in Washington, U.S., September 27, 2021.

Las Vegas used to run an advertising campaign to promote tourism. The ads encouraged visitors to let loose and take advantage of the city’s shops, restaurants, clubs, and casinos with the slogan: “What happens in Vegas, stays in Vegas.”

The line might work for Vegas—but decidedly less so for the rest of the world. In today’s increasingly interconnected era, developments in one country often ripple across borders and affect the entire world. Take the COVID-19 pandemic, which started in China but quickly spread to nearly every country. Similarly, countries’ domestic vaccination policies have resulted in global consequences, namely the failure to allocate vaccines equitably around the world. 

By the end of February 2022, 80 percent of people in high-income countries received at least one vaccine dose, whereas in low-income countries, this measure stood at just 13 percent.

Vaccine inequity has represented a major challenge since the initial development of COVID-19 vaccines, as the uncontrolled spread of the virus can allow it to mutate. Experts have connected vaccine inequity to the emergence of new forms of COVID-19, which have jeopardized lives and the performance of economies around the world.

Despite those risks, many high-income countries vaccinated their populations in the months after vaccines were developed ahead of at-risk groups abroad—a practice known as vaccine nationalism.

In today’s world, domestic and foreign policy are deeply intertwined: what happens abroad affects countries at home—and vice versa. The challenge for policymakers is figuring out how to navigate the complexities of such interconnectedness.

In this lesson, we’ll explore how one country’s approach to vaccinating its population affects the rest of the world.

We are all connected

Let’s back up a bit. You might be asking: How do events in a country thousands of miles away affect me? The answer has to do with globalization—the worldwide movement of people, ideas, money, goods, viruses, and more.

Knowingly or unknowingly, you experience globalization every day. Ever hear a K-pop song? Or watch a foreign-language film? Those experiences show the flow of pop culture across borders. Globalization also allows for the transmission of one country’s problems to the rest of the planet.

For instance, one country’s greenhouse gas emissions can accelerate climate change. Another country’s economic collapse can send shock waves throughout global financial markets. And in a world where billions of people are just a click away, extremist ideologies can inspire acts of violence halfway around the world.

Vaccines as foreign policy 

World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus has said the pandemic “will not be over anywhere until it’s over everywhere.” This sentiment has been a driver behind one of the largest multilateral initiatives to ensure more equitable distribution of vaccines: COVID-19 Vaccines Global Access (COVAX).

Several international organizations, including the WHO, founded COVAX in April 2020. In the following months, the coalition solicited both funds and donations of vaccines to pool and provide to countries with limited vaccine access. The group’s goal was to put two billion shots in arms by the end of 2021, but it fell short of this mark, distributing fewer than one billion vaccines by the year’s end. 

Meanwhile, high-income countries scooped up most of the global vaccine supply. At the end of February 2022, more than 80 percent of the populations of high-income countries have received at least one COVID-19 shot, compared to 13 percent in low-income countries. Those differences become starker as countries with vaccine surpluses administer booster vaccines to their populations, furthering vaccine inequity globally.

Health experts have urged against vaccine nationalism. But decisions balancing the needs of one country with the needs of the world can be complicated. Let’s look at several factors policymakers should consider when forming vaccine policies.

Domestic Politics: In democratic political systems, officials serve the public and must answer to voters through elections. When considering how to allocate vaccine doses between global and domestic populations, leaders—especially those seeking reelection—need to consider the interests of their constituents, who could demand to be first in line for vaccines.

International Standing: Countries can also use vaccines as a diplomatic tool or method to exert soft power. Competition with other world powers is a consideration, as vaccines have become a coveted tool against the pandemic. This, coupled with historic limitations in international cooperation, has spurred the development of homegrown immunological capabilities among countries.  In early 2021, for example, Russia sent vaccine doses around the world for free or at an unbelievably cheap price, filling a void left by the United States and other European nations.

Shipping containers with 300 liters of the first batch of active ingredient to produce Sputnik V vaccines in an Argentine lab are seen on board the Aerolineas Argentinas airplane at the tarmac of Ezeiza International airport in Buenos Aires, Argentina, on

Foreign Policy Priority: The Chinese Communist Party (CCP) came under fire for its initial COVID-19 response amid evidence of government officials delaying disease reporting, undercounting cases, and silencing whistleblowers. The government subsequently sought to use the pandemic to rehabilitate its international image and present itself as a global health leader. To this end, the CCP poured funding into the development of a COVID-19 vaccine and vowed to provide the world with two billion doses after its completion. The vaccine, Sinovac, is the most commonly used COVID-19 vaccine in the world as of February 2022.

In several instances, China has reportedly leveraged this vaccine diplomacy for political ends, including by pushing Guatemala, Honduras, and Paraguay to cut ties with Taiwan and pressuring Brazil to strike deals with a Chinese telecommunications giant. The CCP’s efforts to pursue its foreign policy priorities through vaccine diplomacy, however, have been seriously hindered by Sinovac’s limited efficacy against fast-spreading COVID-19 variants, the development of more effective vaccines produced by U.S. companies, and the CCP’s resistance to investigations into the origins of the initial Wuhan outbreak.

Economic Risks: Countries with high vaccination rates are expected to economically rebound faster than those with slower rollouts. Take the U.S. economy—by September 2021, it had exceeded its pre-pandemic size. Meanwhile, low-income countries could face a much longer road to recovery littered with obstacles, such as setbacks to food security and children’s health.

Although countries could be tempted to prioritize their own economies, experts have said vaccine nationalism could cost high-income countries trillions of dollars [PDF] in lost output given the interconnectedness of trade and reliance on lower-income countries in global supply chains

Health Risks: Vaccination lessens the overall frequency and severity of COVID-19 infections. Governments can be tempted to focus more on domestic vaccine distribution and their own population’s health; however, experts say an equitable global rollout can save the most lives worldwide and diminish the likelihood of new and potentially dangerous variants emerging.

Since the pandemic started, leaders around the world have faced difficult policy decisions about how to keep their populations safe. Let’s find out what you would do if you were president. Play as the head of a fictional country, Genovia. 

Vaccine Nationalism vs. Vaccine Multilateralism

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